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Achieving a high cure rate with direct‐acting antivirals for chronic Hepatitis C virus infection in Cameroon: a multi‐clinic demonstration project

Authors
  • Coyer, Liza1
  • Njoya, Oudou2
  • Njouom, Richard3
  • Mossus, Tatiana2
  • Kowo, Mathurin Pierre2
  • Essomba, Frida2
  • Boers, Alexander4
  • Coutinho, Roel5, 6
  • Ondoa, Pascale7, 8
  • Bilong, Catherine
  • Babagnak, Isabelle Dang
  • Kamto, Dyane
  • Talla, Paul
  • Tchoumi, Eric
  • 1 Public Health Service of Amsterdam, The Netherlands , (Netherlands)
  • 2 University of Yaoundé I, Cameroon , (Cameroon)
  • 3 Centre Pasteur du Cameroun, Cameroon , (Cameroon)
  • 4 Joep Lange Institute, The Netherlands , (Netherlands)
  • 5 PharmAccess Foundation, The Netherlands , (Netherlands)
  • 6 University Medical Center Utrecht, The Netherlands , (Netherlands)
  • 7 African Society for Laboratory Medicine, Ethiopia , (Ethiopia)
  • 8 Amsterdam Institute for Global Health and Development, The Netherlands , (Netherlands)
Type
Published Article
Journal
Tropical Medicine & International Health
Publisher
Wiley (Blackwell Publishing)
Publication Date
Jul 05, 2020
Volume
25
Issue
9
Pages
1098–1109
Identifiers
DOI: 10.1111/tmi.13450
PMID: 32502290
PMCID: PMC7540389
Source
PubMed Central
Keywords
License
Unknown
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Abstract

Objectives Highly effective direct‐acting antivirals (DAAs) for Hepatitis C treatment are largely inaccessible in sub‐Saharan Africa. Data on treatment feasibility and outcomes in clinical settings are limited. We assessed the feasibility of achieving a high (≥90%) cure rate with DAAs in six gastroenterology clinics in Cameroon. Methods Patients with chronic Hepatitis C virus (HCV) infection were treated for 12 or 24 weeks with ledipasvir/sofosbuvir, ledipasvir/sofosbuvir/ribavirin or sofosbuvir/ribavirin, depending on the stage of liver disease and HCV genotype. The cure rate was defined as the proportion of patients with a sustained virological response 12 weeks after treatment completion (SVR12) among all treatment completers. Results We identified 190 HCV RNA positive patients between September‐2017 and August‐2018, 161 (84.7%) of whom started treatment. 105 (65.2%) were female, median age was 61.3 years [IQR = 55.9–66.9] and 11 (6.8%) were HIV‐positive. Median plasma HCV RNA was 6.0 log10 IU/mL [IQR = 5.6–6.4]. HCV genotypes identified were 1 (34.8%), 2 (13.7%), 4 (50.9%), 1 and 4 (0.6%); 46 (28.6%) strains of 160 single‐genotype infections were non‐subtypeable. Of 158 treatment completers, 152 (96.2%, 95%CI = 91.9–98.6%) achieved SVR12. Six patients did not achieve SVR12: five carried HCV with NS5A resistance mutations and one with NS5B resistance mutations. Three patients died before and two after treatment completion. The most common adverse events were asthenia (12.0%), headache (11.4%) and dizziness (18.9%). Conclusion High cure rates of Hepatitis C with DAAs are achievable in clinical settings of Cameroon. However, the accessibility and provision of HCV screening, diagnosis, treatment, monitoring and care should be addressed for large‐scale implementation.

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